0.2% ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery: A double-blind study

Study Objective: To evaluate the effects of adding low concentration of fen tanyl to 0.2% ropivacaine when providing patient-controlled epidural analge sia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia Patients: 32 ASA physical status I, II, and patients, who were scheduled fo r elective major abdominal surgery, including bowel resection, hepatic rese ction, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. Afte r surgery patients were randomly allocated in a double-blind fashion to rec eive PCEA with either 0.2% ropivacaine (n = 16) or 0.2% ropivacaine/2 mu g/ mL fentanyl (n = 16) [background infusion ranging between 4 and 6 mL/hr; wi th 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain durin g coughing, sedation, pulse oxymetry, hemodynamic variables and motor block were evaluated at 1, 6, 12 24, and 45 hours after the end of surgery by a blinded observer. Occurrence of untoward events including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO(2) < 90%) and respiratory, complications, as well as total consumption of PCEA solution and increment al doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side e ffects were observed between the two groups. Patients receiving 0.2% ropiva caine alone requested far more incremental doses (23 doses [0-60] vs. 5 dos es [0-25]) (p = 0.006) and needed far more analgesic solution (230 mt [140- 282] vs, 204 [130-228]) (p = 0.003) than patients receiving the ropivacaine /fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropi vacaine alone (12 h: 91% +/- 2% vs. 95% +/- 2%, p < 0.006 24 h: 93% +/- 1% vs. 96% +/- 2% p = 0.003; 48 h: 92% +/- 1.8% vs. 96% +/- 1% p = 0.004). Conclusions: A thoracic epidural infusion of 0.2% ropivacaine, with or with out fentanyl, provided effective pain relief in most patients with a very l ow degree of motor blockade. ridding 2 mu g/ml fentanyl to 0.2% ropivacaine reduced total consumption of local anesthetic solution and need for increm ental doses, but did not provide clinically relevant advantages in quality of pain relief and incidence of motor block, leading to a significant decre ase in peripheral SpO(2), lasting up to 48 hours after surgery. (C) 2000 by Elsevier Science Inc.